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Promoting Accountability in Health Care Delivery in India

November 3, 2015

By Jackie Ogburn

Fighting a typhoid outbreak in a village in Uttar Pradesh, India, might be as simple as disinfecting a pool of standing water with a bucket of bleach. But getting that bleach to the right person in the right village at the right time requires a system of health and government infrastructure that doesn’t really exist yet.

For his summer internship, Matt Bunyi MPP’16 worked with the government in this northern state in India on making public sector health workers accountable to the community to deliver that bucket, as well as other critically important health services such as immunizations and supplementary nutrition for malnourished children.

Sanford Assistant Professor Manoj Mohanan assigned Bunyi to the position as part of his research project in Lucknow, India. Mohanan is working with a social accountability initiative in collaboration with the Wolrd Bank and the government of Uttar Pradesh. The Uttar Pradesh Health Systems Strengthening Project (UPHSSP) and the State Institute of Rural Development (SIRD) developed the protocols and handled the planning, management and roll-out of the interventions.

The challenge was to plan and design systems where community members can report local problems, such as unavailability of timely child nutritional supplements, to government workers who could have the capacity to solve the problem.

“There was no social accountability,” for the delivery of health services, Bunyi said. Many villagers didn’t know they had a right to services, and those who did, lacked information about where to get services or where to direct complaints.

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From Peace Corps to Public Policy

Matt Bunyi MPP'16 served in the Peace Corps before deciding to enroll in the Sanford School of Public Policy for its expertise in international development.

The project needed to ramp up quickly. At the government office, funds and office spaces were available, but no workers had been hired. Bunyi discovered that part of the problem was that jobs were posted only online, when the local people they needed to hire didn’t have Internet access or skills. He assisted the committee that eventually hired five managers and 27 county-level employees, who in turn will be recruiting 300 community organizers.

Bunyi drew on his experience as a Peace Corps Fellow in Indonesia to understand the local culture, both at the village level and within the government. He took Hindi lessons in the morning before going to work.

“Language brings such big baggage of culture and history,” he said. The lessons helped him understand the mindset of the people he wanted to serve.

The soft skills he had learned in the Peace Corps -- learning the local culture, listening to people and learning about the power dynamics in the group -- were complemented by the hard skills he learned at Sanford. He decided to enroll in the MPP program because of the professors’ depth of experience in international development.

“Working with Manoj (Mohanan) was a fantastic opportunity. I learned so much about how research design and project analysis can help create evidence-based policy. Professor Anthony So taught me how to frame problems to get the best solution,” he said.

“Matt's understanding of the quantitative aspects of the evaluation research, combined with his ability to work creatively in resource-constrained settings, made him very effective in the field,” Mohanan said. “Our project made remarkable progress in planning and design over the summer, and the support that Matt provided was critical in achieving this progress.”